Implantation of intracranial electrodes predicts worse outcome in mesial temporal lobe epilepsy.
Academic Article
Overview
abstract
OBJECTIVE: Anteromesial resection is an effective method for treating seizures arising from the medial temporal lobe, as these cases are often the most straightforward and have the best outcomes. Nevertheless, some patients who go on to have a mesial resection are recommended to have an implantation of electrodes before surgery. Whether the need for such an implant alters the rate of seizure-freedom is not well-studied in this particular subgroup of epilepsy patients. METHODS: We performed a retrospective review of consecutive anteromesial surgeries for medial temporal lobe epilepsy performed between 2005 and 2020. Of a total of thirty-nine patients, nineteen required electrode implantation (Electrode group) and twenty did not (No Electrode group). The primary outcomes assessed were reduction in seizure frequency and Engel score. Complication rates were also compared. RESULTS: Post-resection seizure frequency reduction was non-significantly higher in the No Electrode group (97.0±10.3%) compared with the Electrode group (88.5±23.7%, p=0.15). The rate of Engel I outcome was non-significantly higher in the No Electrode group (84.2%) compared with the Electrode group (65.0%, p=0.17). Major complication rates were non-significantly higher in the No Electrode group (15.8±1.9%) compared with the Electrode group (5.0±1.1%, p=0.26). Power analysis revealed that 74 patients would need to be included in each group to reach statistical significance. CONCLUSIONS: Although not statistically significant, our study showed a trend for improved seizure control if a decision was made not to implant electrodes prior to potentially curative anteromesial resection. Engel I outcome in this group reached approximately 85%. A larger multiinstiutional study may be required to reach statistical significance.
